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Table 3—

Intake of calcium and risk of type 2 diabetes in the Nurses Health Study

Total calcium intake (mg/day)
≤600601–800801–1,0001,001–1,200>1,200P for trend
No. of new cases of diabetes 1,115 1,277 1,084 696 671  
Follow-up person-years 367,985 414,177 338,966 229,764 230,066  
RR (95% CI)       
    Age adjusted 1.00 0.88 (0.81–0.96) 0.85 (0.78–0.92) 0.76 (0.69–0.84) 0.68 (0.62–0.75) <0.001 
    Multivariate without diet* 1.00 0.88 (0.82–0.96) 0.86 (0.79–0.94) 0.80 (0.73–0.88) 0.74 (0.67–0.82) <0.001 
    Multivariate with diet 1.00 0.91 (0.84–0.99) 0.90 (0.82–0.99) 0.85 (0.76–0.95) 0.88 (0.71–0.89) <0.001 
    Multivariate with diet + vitamin D 1.00 0.91 (0.83–1.00) 0.90 (0.81–1.00) 0.85 (0.76–0.96) 0.79 (0.70–0.90) <0.001 
Total calcium intake (mg/day)
≤600601–800801–1,0001,001–1,200>1,200P for trend
No. of new cases of diabetes 1,115 1,277 1,084 696 671  
Follow-up person-years 367,985 414,177 338,966 229,764 230,066  
RR (95% CI)       
    Age adjusted 1.00 0.88 (0.81–0.96) 0.85 (0.78–0.92) 0.76 (0.69–0.84) 0.68 (0.62–0.75) <0.001 
    Multivariate without diet* 1.00 0.88 (0.82–0.96) 0.86 (0.79–0.94) 0.80 (0.73–0.88) 0.74 (0.67–0.82) <0.001 
    Multivariate with diet 1.00 0.91 (0.84–0.99) 0.90 (0.82–0.99) 0.85 (0.76–0.95) 0.88 (0.71–0.89) <0.001 
    Multivariate with diet + vitamin D 1.00 0.91 (0.83–1.00) 0.90 (0.81–1.00) 0.85 (0.76–0.96) 0.79 (0.70–0.90) <0.001 
Dietary calcium intake (mg/day)
≤500501–750751–1,000>1,000P for trend
No. of new cases of diabetes 497 1056 621 291  
Follow-up person-years 172,838 357,642 205,813 113,274  
RR (95% CI)      
    Age adjusted 1.00 0.92 (0.82–1.02) 0.94 (0.83–1.06) 0.86 (075–1.00) 0.09 
    Multivariate without diet* 1.00 0.93 (0.83–1.03) 0.88 (0.78–0.99) 0.81 (0.70–0.94) 0.003 
    Multivariate with diet 1.00 0.96 (0.86–1.08) 0.93 (0.81–1.07) 0.85 (0.72–1.01) 0.06 
    Multivariate with diet + vitamin D 1.00 0.99 (0.88–1.13) 0.99 (0.85–1.15) 0.92 (0.76–1.12) 0.41 
Dietary calcium intake (mg/day)
≤500501–750751–1,000>1,000P for trend
No. of new cases of diabetes 497 1056 621 291  
Follow-up person-years 172,838 357,642 205,813 113,274  
RR (95% CI)      
    Age adjusted 1.00 0.92 (0.82–1.02) 0.94 (0.83–1.06) 0.86 (075–1.00) 0.09 
    Multivariate without diet* 1.00 0.93 (0.83–1.03) 0.88 (0.78–0.99) 0.81 (0.70–0.94) 0.003 
    Multivariate with diet 1.00 0.96 (0.86–1.08) 0.93 (0.81–1.07) 0.85 (0.72–1.01) 0.06 
    Multivariate with diet + vitamin D 1.00 0.99 (0.88–1.13) 0.99 (0.85–1.15) 0.92 (0.76–1.12) 0.41 
Supplemental calcium intake (mg/day)§
≤250251–500>500P for trend
No of new cases of diabetes 3854 657 332  
Follow-up person-years 1,246,189 212,495 122,274  
RR (95% CI)§     
    Age adjusted 1.00 0.74 (0.68–0.81) 0.62 (0.56–0.70) <0.001 
    Multivariate without diet* 1.00 0.90 (0.82–0.98) 0.79 (0.70–0.88) <0.001 
    Multivariate with diet 1.00 0.92 (0.84–1.00) 0.81 (0.72–0.92) <0.001 
    Multivariate with diet + vitamin D 1.00 0.92 (0.84–1.00) 0.82 (0.72–0.92) <0.001 
Supplemental calcium intake (mg/day)§
≤250251–500>500P for trend
No of new cases of diabetes 3854 657 332  
Follow-up person-years 1,246,189 212,495 122,274  
RR (95% CI)§     
    Age adjusted 1.00 0.74 (0.68–0.81) 0.62 (0.56–0.70) <0.001 
    Multivariate without diet* 1.00 0.90 (0.82–0.98) 0.79 (0.70–0.88) <0.001 
    Multivariate with diet 1.00 0.92 (0.84–1.00) 0.81 (0.72–0.92) <0.001 
    Multivariate with diet + vitamin D 1.00 0.92 (0.84–1.00) 0.82 (0.72–0.92) <0.001 
*

RR adjusted for age, BMI, hypertension, family history of diabetes, smoking, physical activity, caffeine, alcohol, and state of residence (southern states [California, Florida, and Texas] or northern states [Connecticut, Maryland, Massachusetts, Michigan, New Jersey, New York, Ohio, and Pennsylvania]).

RR adjusted for everything in footnote ∗ plus type of fat (saturated, polyunsaturated, or trans), cereal fiber, glycemic load, magnesium, and retinol.

Women who were calcium supplement users were excluded at baseline and during follow-up (8,380 at baseline and 51,878 during follow-up). The entire analysis for dietary calcium intake was also adjusted for multivitamin use (yes or no).

§

The entire analysis for supplemental calcium was also adjusted for multivitamin use (yes or no) and dietary calcium intake.

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